Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, The Netherlands.
Department of Nephrology, University of Groningen, University Medical Center Groningen, The Netherlands.
J Am Soc Nephrol. 2021 Jun 1;32(6):1436-1443. doi: 10.1681/ASN.2020081155. Epub 2021 Mar 25.
Health literacy, the ability to deal with information related to one's health, is a predictor of health outcomes in CKD. However, research has not explored whether low health literacy predicts the onset of CKD.
We used data from participants of Lifelines, a prospective population-based cohort study of individuals living in The Netherlands, to assess the share of individuals with low health literacy by eGFR category, whether low health literacy is associated with CKD onset in the general population and in the subgroup of older adults, and whether established CKD risk factors mediate this association.
In the total sample of 93,885 adults (mean follow-up 3.9 years), low health literacy was more likely among individuals in worse eGFR categories, increasing from 26.4% in eGFR category 1 to 50.0% in category 5 (=0.02). Low health literacy, compared with adequate health literacy, was associated with the onset of CKD in the total sample (3.0% versus 2.1%) and in the subgroup of older adults (13.4% versus 11.3%), with odds ratios (ORs) of 1.44 (95% confidence interval (95% CI), 1.31 to 1.59) and 1.21 (95% CI, 1.04 to 1.41), respectively. After adjustment for sex, age, education, and income, health literacy was associated with CKD onset only in older adults (OR, 1.25; 95% CI, 1.04 to 1.50). This association was mediated by hypertension and high body mass index (BMI) in the crude model, but only by BMI after adjustment (with BMI explaining 18.8% of the association).
Low health literacy is a risk factor for CKD onset among older adults, which suggests that CKD prevention might benefit from strategies to address low health literacy.
健康素养是处理与个人健康相关信息的能力，是慢性肾脏病（CKD）结局的预测因素。然而，研究尚未探讨低健康素养是否预测 CKD 的发生。
我们使用 Lifelines 参与者的数据，这是一项针对荷兰人群的前瞻性基于人群的队列研究，评估了根据 eGFR 类别划分的低健康素养者的比例，低健康素养与一般人群和老年人群中 CKD 发病的相关性，以及是否存在既定的 CKD 风险因素会调节这种关联。
在 93885 名成年人的总样本中（平均随访 3.9 年），eGFR 类别越差，低健康素养者的比例越高，从 eGFR 类别 1 的 26.4%增加到 eGFR 类别 5 的 50.0%（P<0.001）。与健康素养充足者相比，低健康素养与总样本（3.0% vs. 2.1%）和老年亚组（13.4% vs. 11.3%）的 CKD 发病相关，比值比（ORs）分别为 1.44（95%置信区间[95%CI]，1.31 至 1.59）和 1.21（95%CI，1.04 至 1.41）。在校正性别、年龄、教育程度和收入后，健康素养仅与老年人群的 CKD 发病相关（OR，1.25；95%CI，1.04 至 1.50）。这种关联在粗模型中通过高血压和高体重指数（BMI）来介导，但在调整后仅通过 BMI 来介导（BMI 解释了关联的 18.8%）。
低健康素养是老年人群 CKD 发病的危险因素，这表明 CKD 预防可能受益于解决低健康素养的策略。
